過去有病史的女性 其早產風險對於治療反應不佳


  May 12, 2008(紐澳良訊)-過去有早產風險的女性,即使接受17-alpha-hydroxyprogesterone caproate(17OHPC)治療預防性安胎治療,其早產風險仍然很高。
  
  過去,這個族群在處於早產高危險的一大群女性中,包括子宮頸較短、吸菸與否、黑人種族、或是那些社會經濟地位較低的,這些都是造成早產的已知危險因子,她們對於治療的反應是最好的。
  
  這項踴躍赴會、受到大家廣泛討論的研究,由喬治亞州Matria Healthcare健康照護臨床研究部門的Niki Istwan護理學學士發表於美國婦產科醫學會第56屆年會上。
  
  這項研究收納了1,177位僅懷一胎、懷孕週數少於27週的女性,且這些女性都有早產的病史,他們接受每週一次的17OHPC注射,直到接近足產;即使接受了這些治療,仍有246位女性發生早產,而被排除在研究之外。
  
  在觀察期間,270位有早產現象,且因此住院;那些沒有早產現象(共有600位)的女性在家待產,直到足產。
  
  整體而言,1,117女性中有517位女性(43.9%)接受17OHPC治療但早產,這些女性中,270位(22.9%)在34週內發生早產;將近四分之三女性(73.3%)的早產有再發的現象。
  
  Istwan小姐表示,在這群早產高風險群女性中,接受17OHPC的女性仍處於早產的高風險。
  
  她在Medscape婦產科與女性健康的訪談中表示,我們能夠確認對17OHPC預防可能會有反應的因子,是過去有早產病史的女性;沒有任何其他標準危險因子會明顯影響治療反應。
  
  Istwan小姐承認,對於17OHPC的安胎特性,我們了解得並不多,但是她強調預防早產的治療選擇是很有限的;她的發表點燃了現場的討論與更多的推測。
  
  在另一項被設計來評估投予17OHPC之後的子宮活性,肯塔基路易維耳大學榮譽教授Kenneth R. Barton醫師表示,針對388位女性投予17OHPC顯然不如預期地降低子宮收縮。
  
  Barton醫師向Medscape婦產科與女性健康表示,該荷爾蒙對於已經有早產症狀的女性顯然沒有安胎作用,即使治療結束後,子宮收縮程度仍再度增加。
  
  他認為,這顯示17OHPC在放鬆子宮方面,是結構上而非生理上的作用,但這代表什麼,我們並不清楚。
  
  這兩項研究都沒有接受經費贊助。Istwan小姐與Barton醫師表示無相關資金上的往來。

Preterm Labor Risk Resistant t

By Martha Kerr
Medscape Medical News

May 12, 2008 (New Orleans) — Women with a history of preterm delivery remain at high risk despite prophylactic tocolytic therapy with 17-alpha-hydroxyprogesterone caproate (17OHPC) treatment.

Yet, this group had the greatest response to the drug among a larger group of women at high risk for preterm labor, including those with a shortened cervix, cerclage, smoking status, black race, or those who were socioeconomically disadvantaged — all known risk factors for premature labor.

Results of the well-attended and much-discussed study were presented here by coinvestigator Niki Istwan, BSN, from the Department of Clinical Research at Matria Healthcare in Marietta, Georgia, at the American College of Obstetricians and Gynecologists 56th Annual Clinical Meeting.

The study involved 1177 women at fewer than 27 weeks' gestation with singleton pregnancies and a history of preterm delivery. Women received weekly 17OHPC injections until reaching full term. Despite treatment, 246 women developed preterm labor followed by delivery and were excluded from the study.

During observation, 270 went into preterm labor and were hospitalized. Those who did not go into early labor (n = 660) were managed at home until they had a full-term delivery.

Overall, 517 women (43.9%) in the entire cohort of 1117 women receiving 17OHPC developed preterm labor, and of these, 270 (22.9%) went into labor at fewer than 34 weeks. Nearly three quarters of the women (73.3%) developing preterm labor had recurrent episodes.

"In this group of women at high risk for recurrent preterm delivery, those women receiving [17OHPC] remained at increased risk for preterm labor and preterm birth," Ms. Istwan reported.

"The only risk factor that we could identify for who might respond to 17OHPC prophylaxis was women with a previous history," she said in an interview with Medscape Ob/Gyn & Women's Health. "None of the other standard risk factors appears to influence response to treatment."

Ms. Istwan acknowledges that little is known about the tocolytic properties of 17OHPC, but she stressed that the arsenal of treatment options to prevent preterm delivery is limited. Her presentation sparked a lively discussion and much speculation.

In a separate study designed to measure uterine activity after administration of 17OHPC, Kenneth R. Barton, MD, professsor emeritus of the University of Louisville, Kentucky, showed that administration of 17OHPC injections did not appear to induce a reduction in uterine contractions, as expected, among 388 women in spontaneous preterm labor.

The hormone "did not appear to exhibit tocolytic properties in women having preterm labor symptoms," Dr. Barton told Medscape Ob/Gyn & Women's Health, "even though uterine contraction increased once therapy has ended.

"We think this shows that 17OHPC has an anatomic rather than a physiologic effect on relaxing the uterus, but what this means, we don't know," he said.

Neither study received commercial grant support. Ms. Istwan and Dr. Barton have disclosed no relevant financial relationships.

American College of Obstetricians and Gynecologists 56th Annual Clinical Meeting: Posters 88 and 92. Presented May 6, 2008.

    
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